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Countdown to Childx: Q&A with pediatric health expert Alan Guttmacher

Countdown to Childx: Q&A with pediatric health expert Alan Guttmacher

jumpforjoyIt’s just a few weeks until the inaugural Childx conference, a TED-style meeting at Stanford that will highlight innovations in health problems of pregnancy, infancy and childhood. (Conference registration for the April 2-3 event is still open, with details available on the conference website.) Childx is attracting nationally and internationally prominent speakers: keynotes will be given by Alan Guttmacher, MD, head of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and by Rajiv Shah, MD, former head of USAID.

I spoke recently with Guttmacher about the upcoming conference. Because I spend most of my time working with scientists who focus their attention on specific research niches within obstetric and pediatric medicine, I was interested in getting his take on the “big picture” of these fields. An edited version of our conversation is below.

What are you planning to say in your keynote address at the Childx conference?

Children’s lives are about more than just health. While biomedical research is crucial to improving kids’ lives, we should put it in the larger context of kids’ lives and do not just research that has an impact on health, but also on children’s overall well-being.

Within the health sphere, I’ll talk about several areas where we need more research. We need to study how to do a better job of preventing prematurity, both to gain a better understanding of biological and environmental causes of preterm birth, and also of how to do a better job of employing the knowledge we already have.

Another topic I’ll address is vaccination: How do we both pursue the science of vaccination to figure out how to make more vaccines more effective, and also, how do we work with parents so they make decisions about kids’ lives that are in the best interests of the kids and are evidence based, rather than based on, say, something they recently read on the web?

I’ll also discuss the developmental origins of health and disease. Pediatricians have always been very invested in anticipatory guidance, telling families about the kinds of things to do to prevent future disease for their children. But this goes farther; this is the idea that health factors, not only in childhood but even in utero, have lifelong impact on health. For instance, what happens in pregnancy potentially has large impact on whether someone develops hypertension in their 60s or 70s. We’re beginning to do science that will tell us the connections between early factors and later health, that will actually influence health along the entire age span. It’s an area of very important research.

And I’ll address intellectual and developmental disabilities. We need research to figure out how to more effectively prevent intellectual and developmental disabilities, research to understand how to allow kids who have these disabilities to function more effectively in society, and also research to figure out how to have society function better in the lives of kids with intellectual and developmental disabilities.

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Events, In the News, Medical Education, Medical Schools, Stanford News

Match Day at Stanford sizzles with successful matches & good cheer

Match Day at Stanford sizzles with successful matches & good cheer

Rowza Rumma, hugs Jennifer DeCoste-Lopez, at Match Day 2015 at Stanford School of Medicine on March 20, 2015. ( Norbert von der Groeben/Stanford School of Medicine )Across the country at the exact same time — 9 AM in California — on the third Friday in March, graduating medical students assemble for Match Day, the day they receive their assignments to residencies.

It’s a spectacle — a cross between a graduation celebration replete with champagne and balloons and a theater audition with tears and heartbreak. The Stanford students, no surprise, are top-notch, so there were more grins than groans and plenty of congratulations and good cheer for all.

The stats themselves stand out: 77 students were matched Friday and they’re heading to 14 states, with California and Massachusetts leading the list. (A map showing where everyone is headed is below.) General medicine is the most popular specialty, followed by anesthesia, neurosurgery and pediatrics. No Stanford students were matched in urology, radiology and psychiatry.

Before the event, I checked in with two graduating students, Mia Kanak and Rowza Tur Rumma. Both are accomplished health professionals with interesting backgrounds and plans to make the world a better place. Kanak is a Tokyo native who hopes to help impoverished children. Rumma wants to translate the success of the world’s best operating rooms into practices that work in the poorest nations.

As I wrote in a story:

For [Rumma], the day was both exciting and nerve-wracking. “I think it’s hard to not have the jambalaya of those issues in our minds,” she said. Clutching the red envelope and a cell phone, she was dialing repeatedly, trying to get in touch with her parents in Bangladesh to share the moment with them.

Finally, her father on the phone, Rumma slit open the envelope, a relieved grin spreading across her face. “It’s Brigham,” she said, her first choice. Brigham and Women’s Hospital offers opportunities for its surgical residents to specialize in global health, just the program Tur Rumma was hoping for. For the residency, she was interviewed by Atul Gawande, the well-known author and surgeon, and was able to discuss her work during a summer program in Bangladesh, where she worked to implement — and adapt — a checklist of steps to reduce surgical complications adopted by the World Health Organization.

Kanak also secured her first choice, a berth in the Boston Children’s Hospital‘s pediatrics program.

“I want to say how proud all of us at Stanford Medicine are of your accomplishments today,” Dean Lloyd Minor, MD, told the group after envelopes had been torn open. “And now, on behalf of everyone, a toast to your success, to the impact you’re going to have on the lives of so many people moving forward: Best wishes!”

View Stanford Residency Match Day 2015 in a full screen map

Previously: Stanford Medicine’s Match Day, in pictures, It’s Match Day: Good luck, medical students!, At Match Day 2014, Stanford med students take first steps as residents and Image of the Week: Match Day 2012
Photo of Rowza Tur Rumma by Norbert von der Groeben; map by Kris Newby

Events, Medical Education, Stanford News

Stanford Medicine’s Match Day, in pictures

Stanford Medicine's Match Day, in pictures

There was a lot of excitement at the medical school campus today, where 77 students found out where they’ve been “matched” for their residencies. Norbert von der Groeben captured the celebration through a series of photos; watch for more on the morning’s event here on Monday.

Previously: It’s Match Day: Good luck, medical students! and At Match Day 2014, Stanford med students take first steps as residents

Behavioral Science, Complementary Medicine, Events, Stanford News

His Holiness the 17th Karmapa discusses the nature of compassion

20150317-CCARE-17th-Karmapa-7343When he was taken from his village in eastern Tibet at age 7 after being identified as a religious leader, His Holiness the 17th Karmapa didn’t have aspirations to become a world-renowned spiritual leader. “My first thought was this new position would give me many more opportunities to play and many more friends to play with,” His Holiness said Tuesday, in one of his first appearances on a two-month tour of the United States.

Now 29, he certainly attracted many “friends” Tuesday; fans and followers packed Stanford’s sizable Memorial Hall for the evening talk. Though his English is quite good, His Holiness used an interpreter to tell tales of his childhood and escape to India at age 14 and to share his thoughts on the nature of compassion and hopes for the protection of the environment.

He told the audience that he learned about compassion early, while living with his parents and siblings in a one-room tent made of yak hair. Every morning, his parents prayed — “May all sentient beings be happy” — again in the evening, they prayed. And they taught him about the interdependence of all beings — even insects could not be smashed. “I really feel I was raised in a mandala, or circle, of compassion and love,” he said.

Even the way his parents gave him up, letting him leave to pursue his future as a spiritual leader, was altruistic, His Holiness said. “They embraced the idea the Karmapa would accomplish great, excellent benefits for the world.”

His Holiness said he has come to learn that compassion is all about thinking about the feelings, and interests, of others. “It’s all about developing a sense of responsibility in relation to the reality of interdependence,” he said, before elaborating:

 I think what compassion involves is not just looking at our own situation, but considering  the state or reality of other sentient beings, those similar to us and those dissimilar to us… and developing a concern for those people.

Compassion involves realizing that our experience of happiness and suffering is the same as everyone else’s. Compassion has this component of awareness to it and knowledge that everyone is wanting to be happy and free of suffering.

For example, His Holiness said he is hoping to teach others in Himalayan monasteries about the importance of caring for the environment. “Compassion means becoming more involved,” he said.

He explained that his passion for the environment stems from his experience growing up in rural Tibet, which he said was beautiful and unaffected by development or pollution. “If I were to return to Tibet, the sad thought occurs to me that maybe things wouldn’t be as beautiful as I remember,” he said.

Though there’s much work to do to protect the environment, and “the actions of one individual are not going to be enough,” he said he still believes “it’s really important for individuals to take up the cause.”

The event was sponsored by the Center for Compassion and Altrusim Research at Stanford and was followed by a Q&A session with James Doty, MD, center founder and director.

Previously: The Dalai Lama talks business, compassion and happiness, Dalai Lama and Stanford researchers explore the science of compassion and altruism and Buddhist teacher Jack Cornfield on practicing “sensitivity to now”  
Photo by Christopher Wesselman

Events, Global Health, Health Costs, Health Disparities, Health Policy, Stanford News

Global health expert: Economic growth provides opportunity to close the “global health gap”

Yamey talkStanford’s Center for Innovation in Global Health hosted a recent seminar for Stanford students and faculty with global health-policy expert Gavin Yamey, MD, MPH. The discussion focused on the disparity in heath care between higher- and lower-income countries and how economic growth in lower-income countries could set the stage for big improvements in global health.

During the talk, Yamey explained that millions of lives could be saved if economic gains in low- and lower-middle-income countries were invested in health care. “I can’t think of any other investment on the planet that could improve human welfare in such a huge way,” Yamey told the audience.

As described in an online story on the event, Yamey cited Rwanda – a country that rebuilt its economy and healthcare after the 1994 genocide – as an example of how this scenario could play out elsewhere:

Over the past decade, Rwanda has experienced significant drops in mortality associated with HIV, malaria and maternal death, and achieved the greatest drop in child mortality rates in recorded history. While scholars acknowledge several factors that contributed to such an extraordinary rebound, government spending on public health, the smart use of aid, and economic growth were all integral to the equation.

“We have an extraordinary opportunity to bring down maternal, newborn and infectious disease deaths to universally low levels everywhere,” Yamey said. “But for that to happen, we need an aggressive scale up of existing tools and interventions, investment in new tools and a build-up of delivery systems.”

Previously: Minimum wage: More than an economic principle, a driver of healthHealth care in Haiti: “At risk of regressing”Child-mortality gap narrows in developing countries and Stanford general surgeon discusses the importance of surgery in global health care
Photo, of Gavin Yamey (left) and moderator Paul Costello, courtesy of the Center for Innovation in Global Health

Behavioral Science, Complementary Medicine, Events, Research, Stanford News

Tend and befriend — helping you helps me

Tend and befriend — helping you helps me

7005743072_b8c1acb3d0_kHelping others helps you. That’s not new news — perhaps you’ve heard it from your mother or your priest or your great-uncle Joe for your entire life. But what is new is the firm biological basis of that old adage — the connections between altruism, caring and neuroscience. Health psychologist and Stanford lecturer Kelly McGonigal, PhD, drove that point home hard last week at a talk sponsored by the Stanford Center for Compassion and Altruism Research and Education.

The event kicked off with a meditation tailored to open hearts and minds outward — for participants to consider others as well as themselves. Even that five-minute exercise was enough to spur the release of oxytocin, sometimes called the “love hormone,” McGonigal said. It “fine tunes our social instincts,” she explained. It dampens fear, making it easier to help others and even improving one’s ability to read facial expressions.

“We can create this biology by choosing to have a social response to stress,” McGonigal told the audience. The academic term is “tend and befriend,” coined by UCLA psychologist Shelley Taylor, PhD. Rather than making her aggressive, Taylor and her colleagues found they softened when stressed, becoming more caring and pro-social.

A series of studies have demonstrated the power of the tend and befriend response. Urban teens who volunteer alleviate their own biological stress. Adults who contribute to charity are more resilient in the face of major life events. People feeling a time crunch — too much to do, too little time — can alleviate the feeling by spending time on others. And the list goes on.

“There’s something about this tend and befriend mindset that seems to create physical resilience,” McGonigal said.

Evolutionarily, the instinct makes sense in the event of a disaster, she said. “I have it so you all will survive if there’s an emergency. My having the tend and befriend instinct is mostly about you.”

Perhaps one of the most relevant illustrations of the tend and befriend response — and a lesson for adopting it — comes from study that just came out this week, McGonigal said. Two researchers asked 150 middle-age adults to tell the story of their lives. The stories from the mentally healthiest participants shared a similar theme: Personal suffering inspired them to do something to transform the suffering of others into something positive. They transformed their suffering from a negative into a positive.

“Helping others increases the chemistry of hope and courage and dampens fear and despair,” McGonigal said.

Previously: Ask Stanford Med: Stanford health psychologist Kelly McGonigal taking questions on willpower, Stanford health psychologist Kelly McGonigal discusses how stress shapes us and Why stress might not be so bad
Photo by David Hodgson

Addiction, Behavioral Science, Ethics, Events, In the News, Media

At Stanford visit, Glenn Beck addresses compassion, change and humility

At Stanford visit, Glenn Beck addresses compassion, change and humility

glennUntil this week, I wouldn’t have associated radio personality Glenn Beck with compassion. And when Jim Doty, MD, director of Stanford Medicine’s  Center for Compassion and Altruism Research and Education invited Beck to the Stanford campus, he realized the right-of-center author and provocateur might be a tough sell to his audience accustomed to guests such as the Dalai Lama and Sri Sri Ravi Shankar.

“Please trust me,” Doty tweeted last week.

Yet fireworks were absent from the nearly two-hour conversation, which ranged from Beck’s struggle with addiction to his Mormon faith and his passion for radio.

Beck came across as human, a man who had endured struggles, made mistakes and is striving to learn from them. He is a father and husband, who organizes charity efforts and volunteers in his church. He said he’s gone from a person for whom the audience size was just a measure of his success to a man who cares deeply about people and his audience members. He prays for humility and said he is not trying to be divisive.

“I spend a lot of time, at the end of my day, saying, ‘Okay, am I that guy? What could I have done better,'” Beck said. “You self-examine all the time and with that self-examination you grow. It’s good. I know who I am because I’m pushed up against the wall all the time.”

Americans share a certain set of principles in common, Beck said. The rift begins when people replace their principles with specific interests and policies.

“For example, if I said to you, ‘Do we torture?’,” Beck said. Nearly everyone would say no. But once threats from terrorists are introduced, the conversation becomes more divided.

“The left and the right have principles in common. We may disagree on interests, but we have to start anchoring ourselves in the principles.”

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Events, Medicine and Society, Patient Care, Stanford News

Author-physician Atul Gawande on dying and end-of-life care

Author-physician Atul Gawande on dying and end-of-life care

Dr Atul Gawande, MD, MPH, Professor, Department of Health Policy and Management Harvard School of Public Health Harvard Medical School, gives a lecture ?Being Mortal: Medicine and What Matters in the End? on Monday, March 2, 2015, at Cynthia and Alexander Tseng, Jr., MD, Memorial Lectureship at Berg Hall Li Ka Shing Learning and Knowledge Center at Stanford School of Medicine . ( Norbert von der Groeben/ Stanford School of Medicine )When Atul Gawande, MD, MPH, witnessed the untimely and inevitable passing of patients, friends and his father, the shortcomings of our medical system’s approach to dying were revealed to him. As the noted author and surgeon told an overflow crowd at Stanford’s medical school earlier this week, he became inspired to “pick up my journalist’s pen” and explore questions about life and mortality that his elite medical education hadn’t equipped him to remedy.

Headlining the eighth annual Cynthia and Alexander Tseng, Jr., MD, Memorial Lecture, the former Stanford undergrad introduced his talk on end-of-life issues with the observation that begins his New York Times #1 book, Being Mortal: “I learned about a lot of things in medical school, but mortality wasn’t one of them.”

In a highly personal, and at times moving, talk, Gawande went on to discuss how decades of modern medical advances have changed our attitudes about dying and death. As fewer diseases and injuries pose life-threatening risks due to vastly improved medications and therapies, people simply expect to live longer. Well-being has become synonymous with longer and more robust life, supported at every stage by effective medical interventions, including a growing market of “lifestyle” rather than life-saving treatments.

Gawande argued that while health and medicine advances are of course positive, one consequence is that we have “medicalized our mortality” to the point where even terminally ill patients and their families look to their doctors for life-saving answers.

“Well, I didn’t [have the answers],” Gawande said.

Gawande said that medicine’s typical approach is to trade time and quality of life in the short term for longer life in the future, but the trade-off isn’t always a good one. For example, aggressive cancer treatment can be debilitating and painful, and often fails to prolong life, merely making the end of life miserable for patients.

In contrast, the goal of palliative care is to create the best possible day for patients today, regardless of what it means for the future. Studies show that for terminally ill patients palliative care improves quality of life, including people’s sense of control and empowerment over their lives. While these positive attitudes may be expected, palliative care practices reduce unwanted medical procedures (as well as costs) and have been shown to actually increase life span – by 25 percent in one study of late-stage lung cancer patients.

“If palliative doctors were a drug, the FDA would approve them,” Gawande told the audience.

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Ask Stanford Med, Cardiovascular Medicine, Events, Genetics

A conversation about using genetics to advance cardiovascular medicine

A conversation about using genetics to advance cardiovascular medicine

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In recognition of American Heart Month, Stanford Health Care is hosting a heart fair on Saturday. The free community event includes a number of talks ranging in topic from the latest developments in treating atrial fibrillation to specific issues related to women’s heart health.

During the session on heart-disease prevention, Joshua Knowles, MD, PhD, will deliver a talk titled “How We Can (and Will) Use Genetics to Improve Cardiac Health.” Knowles’ research focuses on familial hypercholesterolemia, a genetic disease that causes a deadly buildup of cholesterol in the arteries. He and colleagues recently launched a project that uses a big-data approach to search electronic medical records and identify patients who may have the potentially fatal heart condition.

To kick off the conversation about preventing heart disease, I contacted Knowles to learn more about how the genomics revolution is changing the cardiovascular medicine landscape and what you can do to determine if you have a genetic heart disorder. Below he explains why heart disease is a “complex interplay between genetics and environment” and what the future may hold with respect to personalized treatments and pharmacogenetics.

Let’s start by talking about your work on familial hypercholesterolemia (FH). How has the understanding of the genetic basis of FH evolved over the last few years, and what key questions remain unanswered?

For FH, there has been a revolution in our understanding. FH causes very elevated cholesterol levels and risk of early onset heart disease. We used to think that it affected 1 in 500 individuals, but recent studies have pointed out that this is probably an underestimate and it may affect as many as 1 in 200 people. This means that there may be as many as 1 million people in the United States who are affected. We have also identified new genes that cause FH, and the identification of some of these genes has directly translated into the development of a new class of drugs (so called PCSK9 inhibitors) to treat this condition.

What steps can patients take to determine if they are at risk of, or may have, a genetic cardiovascular disorder like FH?

The easiest way is to know about your family history of medical conditions- to know what illnesses affected parents, grandparents, uncles, aunts and other relatives. Of course, genes aren’t the only things that are passed in families. Good and bad habits, such as exercise patterns, smoking and diet, are also passed down through the generations. But a family history of heart disease or certain forms of cancer is certainly a risk factor.

Past research suggests that patients with a genetic predisposition to heart disease can significantly reduce their chances of having a heart attack or stroke by making changes to their lifestyle, such as eating a diet rich in fruits and vegetables. Can lifestyle changes overcome genetics?

Heart disease is a result of the complex interplay between genetics and environment – lifestyle, for instance. For some people with specific genetic conditions, such as familial hypercholesterolemia or hypertrophic cardiomyopathy, the effect of genetics tends to dominate the effect of environment because the genetic effect is so large.

For the vast majority of people without these “Mendelian” forms of heart disease, which follow the laws of inheritance were derived by nineteenth-century Austrian monk Gregor Mendel, it’s difficult to determine at an individual level how much of the risk is due to genes and how much is due to environment (this is for things like high blood pressure, high cholesterol, coronary disease). One clue is certainly family history. However, for most of these diseases the genes are not “deterministic” – that is, people are not destined to have these diseases. Some are more at risk than others, but there are certainly ways to mitigate genetic risk through lifestyle choices. Choosing not to smoke and exercising regularly are two examples of ways you can help to greatly minimize genetic risk.

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Events, Science, Science Policy, Stanford News, Technology

The challenge – and opportunity – of regulating new ideas in science and technology

The challenge – and opportunity – of regulating new ideas in science and technology

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Innovation in science and technology holds promise to improve our lives. But disruptive business models, do-it-yourself medical devices, and open platforms also introduce corporate and personal risks. How can the public stay safe from unknown consequences as a company’s product or service matures? In a recent panel co-sponsored by Stanford’s Rock Center for Corporate Governance and Center for Law and the Biosciences, experts in law, business, and ethics discussed what happens when science and technology outrun the law.

Talk of drones, app-based car services, and music-sharing technologies teased out key issues currently disrupting legal paradigms. But biomedical science took center stage. “Health is more regulated than any other [area]” said panelist Hank Greely, JD, the Deane F. and Kate Edelman Johnson Professor of Law and director of the Center for Law and the Biosciences. He characterized the FDA’s processes as useful in slowing innovation in the health space but noted that rigorous pre-market regulation “won’t work in most parts of the economy.”

What happens when regulation is beyond reach? Greely noted that even if the FDA could limit an entrepreneurial company, it couldn’t conquer the DIY market. He referenced a procedure known as transcranial direct current stimulation, which, by applying electrodes to the head, can feel like “Adderall through a wire” or alter a person’s mood according to placement. A transmitting device is so simple to make, Greely said, “the hardest part will be finding an open Radio Shack.”

Moderator Dan Siciliano, JD, faculty director of the Rock Center and professor of the practice of law, asked the panelists which under-regulated technologies they found frightening. Vapor cigarettes, answered Eleanor Lacey, JD, for luring youth through fruit flavors and targeting them through advertising channels prohibited for regular cigarettes. (As previously reported on Scope, the FDA announced last spring that it would regulate the sale, but not marketing, of e-cigarettes.)

Lacey, vice president, general counsel and secretary of SurveyMonkey, discussed regulation issues involving health information that is transmitted on the company’s platform, where users own their data. She pointed to instances of users creating surveys on which respondents shared HIPAA-protected information, admitted suicidal thoughts, or confessed to crimes. The company cooperates with law enforcement in a very narrow set of sensitive situations but also upholds neutrality of the user-owned space and the user right to control the content: “You don’t want us to be able to shut it down,” Lacey said.

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